Universal healthcare does not look the same everywhere: Divergent experiences with the private sector in Brazil and Thailand

Harris, Joseph; Maia, Juliana Libardi

doi:10.1080/17441692.2021.1981973

Cited by 7 publications

(14 citation statements)

References 51 publications

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“…Articles also explored health professions engaged in the private sector as professionals owning businesses in the health sector (ie, doctors) or joining to form medical cooperatives, as in the case of Brazil and India. 43 The business sizes of the private sector groups identified in the articles ranged from small, medium to large and also spanned subnational, national and global scales. For example, multinational companies such as those in the case of retail pharmacies 44 or the insurance industry 45 were present in some papers; most, however, dealt with national or subnational industries ( figure 3 ).…”

Section: Resultsmentioning

confidence: 99%

“…In Thailand, a focus on medical tourism was driven by the Board of Investment, Tourism Authority of Thailand and Ministry of Commerce, in opposition to the Ministry of Public Health and its goals around narrowing disparities in quality and access between private and public health sectors. 43 …”

Section: Resultsmentioning

confidence: 99%

“…In Brazil, for example, private health sector interests were ‘already quite entrenched with strong organised interests during the drafting of the Constitution’, bolstering the ability for sectors such as the private health insurance industry to enjoy tax exemptions and monopoly creation (p. 1812). 43 In Nigeria, individuals advocating for the introduction of health maintenance organization (HMO) into the Nigerian system, as well as the insurance industry, played a key role in promoting an HMO-based system for private healthcare in the 1990s. 48 A paper that focused on managed care in Latin America discussed the ‘silent process of policymaking’ involving these companies and their involvement in health sector reforms (p. 1245) 45 .…”

Section: Resultsmentioning

confidence: 99%

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The role of private healthcare sector actors in health service delivery and financing policy processes in low-and middle-income countries: a scoping review

Sriram,

Yilmaz,

Kaur

et al. 2024

BMJ Glob Health

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The expansion of the private healthcare sector in some low-income and middle-income countries (LMICs) has raised key questions and debates regarding the governance of this sector, and the role of actors representing the sector in policy processes. Research on the role played by this sector, understood here as private hospitals, pharmacies and insurance companies, remains underdeveloped in the literature. In this paper, we present the results of a scoping review focused on synthesising scholarship on the role of private healthcare sector actors in health policy processes pertaining to health service delivery and financing in LMICs. We explore the role of organisations or groups—for example, individual companies, corporations or interest groups—representing healthcare sector actors, and use a conceptual framework of institutions, ideas, interests and networks to guide our analysis. The screening process resulted in 15 papers identified for data extraction. We found that the literature in this domain is highly interdisciplinary but nascent, with largely descriptive work and undertheorisation of policy process dynamics. Many studies described institutional mechanisms enabling private sector participation in decision-making in generic terms. Some studies reported competing institutional frameworks for particular policy areas (eg, commerce compared with health in the context of medical tourism). Private healthcare actors showed considerable heterogeneity in their organisation. Papers also referred to a range of strategies used by these actors. Finally, policy outcomes described in the cases were highly context specific and dependent on the interaction between institutions, interests, ideas and networks. Overall, our analysis suggests that the role of private healthcare actors in health policy processes in LMICs, particularly emerging industries such as hospitals, holds key insights that will be crucial to understanding and managing their role in expanding health service access.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

The role of private healthcare sector actors in health service delivery and financing policy processes in low-and middle-income countries: a scoping review

Sriram,

Yilmaz,

Kaur

et al. 2024

BMJ Glob Health

View full text Add to dashboard Cite

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“…This strategy aims at reorganizing (expansion, qualification, and consolidation) primary care in the country [18]. However, according to the analysis carried out by Harris and Libardi Maia [19], the private sector has grown over time, generating influence in health policy and weakening the public sector, despite the growing efforts of the latter. Regarding the organizational structure of the health system, the body responsible for ensuring quality and regulating private health insurance is the National Council of Supplementary Health (ANS).…”

Section: Strengths and Inefficiencies Of The Health System In Brazilmentioning

confidence: 99%

Comparison of the healthcare system of Chile and Brazil: strengths, inefficiencies, and expenditures

Cerda

García

Rivera-Arroyo

et al. 2022

Cost Eff Resour Alloc

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Background Governments in Latin America are constantly facing the problem of managing scarce resources to satisfy alternative needs, such as housing, education, food, and healthcare security. Those needs, combined with increasing crime levels, require financial resources to be solved. Objective The objective of this review was to characterizar the health system and health expenditure of a large country (Brazil) and a small country (Chile) and identify some of the challenges these two countries face in improving the health services of their population. Methods A literature review was conducted by searching journals, databases, and other electronic resources to identify articles and research publications describing health systems in Brazil and Chile. Results The review showed that the economic restriction and the economic cycle have an impact on the funding of the public health system. This result was true for the Brazilian health system after 2016, despite the change to a unique health system one decade earlier. In the case of Chile, there are different positions about which one is the best health system: a dual public and private or just public one. As a result, a referendum on September 4, 2022, of a new constitution, which incorporated a unique health system, was rejected. At the same time, the Government ended the copayment in the public health system in September 2022, excluding illnesses referred to the private sector. Another issue detected was the fragility of the public and private sector coverage due to the lack of funding. Conclusions The health care system in Chile and Brazil has improved in the last decades. However, the public healthcare systems still need additional funding and efficiency improvement to respond to the growing health requirements needed from the population.

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“…Apidechkul et al [8] reported that more than 30% or 540,000 people who do not have Thai identification cards (ID cards) which are used to gain access to free public services including seeking employment, education for children, and healthcare services. Therefore, the absence of a Thai ID card leads to an inability to fully access healthcare services that support a good quality of life [9,10]. Furthermore, those who lack a Thai ID card face stigma from people around them through several processes.…”

Section: Introductionmentioning

confidence: 99%

Healthcare service utilization of hill tribe children in underserved communities in Thailand: barriers to access

Moonpanane

Pitchalard

Thepsaw

et al. 2022

BMC Health Serv Res

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Background Hill tribe children, an ethnic minority group in Thailand, experience wide-ranging social and health inequalities. Previous reports indicate that hill tribe children, especially age under 5 years, face social health disadvantages but little is known about the underlying causes. Exploring healthcare utilization among hill tribe children is therefore essential and it may well provide some insight. Methods A qualitative study was conducted using purposive sampling techniques to recruit participants based on our criteria. In-depth interviews and focus-group discussions were employed to explore the experiences of parents (n = 20), community leaders (n = 20), and healthcare providers (n = 20) when caring for children aged under 5 years. Interview transcripts were coded, and thematic analysis was then performed. Results The participants shared their experiences with accessing healthcare services in underserved areas. Barriers to access was the central theme identified. Sub-themes included: (1) distance matters, (2) education and socioeconomic deprivation, (3) lack of cultural sensitivity, (4) communication problems, (5) tradition, beliefs, and differences in cultural practice, (6) lack of child health professionals, and (7) bureaucratic hurdles. Conclusions Healthcare services and environments must be transformed to provide healthcare services, education, and information appropriate to the cultures and beliefs prevalent in the hill tribe population.

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Universal healthcare does not look the same everywhere: Divergent experiences with the private sector in Brazil and Thailand

Cited by 7 publications

References 51 publications

The role of private healthcare sector actors in health service delivery and financing policy processes in low-and middle-income countries: a scoping review

The role of private healthcare sector actors in health service delivery and financing policy processes in low-and middle-income countries: a scoping review

Comparison of the healthcare system of Chile and Brazil: strengths, inefficiencies, and expenditures

Healthcare service utilization of hill tribe children in underserved communities in Thailand: barriers to access

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